RURAL HEALTH: Study Cites Deficiencies, Limitations
Rural health providers are often forced to give care in a "quality vacuum," devoid of the "supporting systems and tools that, ideally, help HMOs and other health care systems coordinate care in urban areas," according to a report to be released today. Dr. Andrew Balas, director of the Center for Health Care Quality at the University of Missouri-Columbia, and colleagues, in analyzing previous studies of rural health in the U.S. and Europe, found that staffing shortages force rural doctors to "spend 16% more time doing direct patient care" and see 38% more patients than their urban counterparts. Thus, they have "less time to manage their practices, educate patients and provide preventive care." The study adds that rural residents "tend to be older and poorer" than city dwellers, and less likely to be covered under managed care, as "Medicare HMOs have pulled out of more than 100 rural counties in the past two years." Balas said, "For all the attacks on their practices, managed care plans do pay some attention to quality and at least in some areas do make systematic efforts to improve their services." The result of all these factors, the study notes, is deficiencies in rural health. Balas said, "Because of the shortcomings in preventive services and care coordination, people who live in rural areas are more vulnerable to developing serious illness. And when they do become sick, it is more difficult for them to actually get the health care services they need, so that their condition worsens." For example, rural patients are 10% less likely "to receive screening such as mammograms, Pap smears and diabetic eye exams," and rural mothers are almost "twice as likely to deliver babies by Cesarean section (31%) than moms in urban hospitals (19%)." Balas said, "There's this whole world of health care outside managed care, and this world shouldn't be forgotten in debates on the quality of health care. ... It's clear that managed care is not going to provide the framework for quality improvement in these areas, so we need to try some new solutions and see what models really might work for these areas" (Bowman, Scripps Howard/Denver Rocky Mountain News, 7/25).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.